Ospital ng Maynila Medical Center DEPARTMENT OF PEDIATRICS Quirino Avenue corner Roxas Boulevard Malate, Manila
Patient’s Name: Bayao, Alrasyzza 1837506 Address: Blk 1 Habitat Row 3 Unit 21 Baseco Port Area, Intramuros Manila Age/Sex: 2 yo/female Date Admitted: May 19, 2008 Admitting Diagnosis: Typhoid Fever Vs Dengue Fever Syndrome Physician–in-charge: Dr. Salloman/Manalo Clerk-in-charge: Erum/Fernando/Figueras/Fuentes/Cuvin/Florentino/Kalalo/Lingao/Liwag/Lopez
48 hour history This is a case of a 2 year-old female, from Baseco, Manila, who came in due to undocumented fever. HISTORY OF PRESENT ILLNESS 3 days PTA, patient had fever, temperature undocumented with associated productive cough, with gteenish sputum, and colds. Patient’s mother gave her Paracetamol (Tempra®) 5ml which she took every four hours. No relief of symptoms were noted. 1 day PTA, fever persisted, patient continued to take Paracetamol, 5 ml every 4 hours. Patient also experienced vomiting of previously ingested food, 2 bouts about 200 cc per bout. Diarrhea was also experienced, 4 bouts, approximately 200 cc per bout. Few hours PTA, persistence of symptoms with associated solitary petechia all over the body prompted consult at this institution. No spontaneous bleeding tendencies noted. PAST MEDICAL HISTORY Patient was born to a 28 yo G1P1 mother via NSD, with no fetomaternal complications. Immunizations: (+) BCG x 2 doses, (+) DPT x 2 doses, (+) Hep B x 2 doses No previous hospitalizations. FAMILY HISTORY The patient’s mother denies any family history of asthma, diabetes mellitus, cardiac disease or respiratory diseases. PERSONAL AND SOCIAL HISTORY: Paient is a cheerful child. Development at par with age. Patient lives with her parents in a 25m 2 concrete house in Baseco, Port area. The house has 2 windows, with 1 pourflushed bathroom. Drinking water is boiled from NAWASA. Garbage is collectd daily. PHYSICAL EXAMINATION: General: awake, alert Vital Signs: BP= 90/50 HR = 170 RR = 40 Temp = 39.60C Wt: 11.3 kg SHEENT: good skin turgor, anicteric sclera, pink palpebral conjunctiva, no tonsillopharyngeal congestion, no cervical lymphadenopathy, no nosoaural discharge, (+) generalized petechial rash Chest/Lungs: SCE, no retractions, (+) crakles both mid lung fields Cardiac: adynamic precordium, NRRR, no murmur Abdomen: flat, NABS, soft, no tenderness, liver span 6cm RMCL Extremities: grossly normal extremities, full pulses, no cyanosis, no edema, CRT >2 s ASSESSMENT: Typhoid Fever Vs Dengue Fever Syndrome PLAN: For admission
Patient was admitted at the PICU under the service of Drs. Troncales/Salloman/Manalo. Laboratories requested were CBC PC, BT, PT, PTT, CXR APL. Patient’s diet was as tolerated except dark colored foods. IVF: D50.3 NaCl 500cc to run at a rate
of 56-57µgtts/min. May have O2 support via cannula at 2-3 lpm. Medic`ations started were: Paracetamol 120mg TIV q4 prn for fever. One unit of FFP properly typed and crossmatched was secured, to be transfused for 3 hours. Vital signs with BP monitoring every hour. Hypotension and signs of bleeding were watched out for. On the 1st hospital day, patient was still febrile. FFP transfusion was deferred. Repeat CBC with PC, blood CS, Stool CS, fecalysis and typhidot were done. For repeat PT, PTT, PPD. Chloramphenicol was started 300mg/SIVP q6 (106mkd). The patient became hypotensive and was given PNSS 20cc/kg IV bolus. Vital signs were monitored every hour. On the 2nd hospital day, diet was maintained. IVF TF: D5 0.3NaCl 1L to run at 58cc/hr. Put on O2 funnel at 5lpm. Ranitidine was started 15mg/IV q8. Other medications were continued. Vital signs were monitored every hour. Hypotension, narrow pulse pressure and signs of bleeding were watched out for.